Laparoscopic Roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial

Abstract

Objectives: This prospective, randomized trial compared the safety and effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGBP) and laparoscopic mini-gastric bypass (LMGBP) in the treatment of morbid obesity.

Summary background data: LRYGBP has been the gold standard for the treatment of morbid obesity. While LMGBP has been reported to be a simple and effective treatment, data from a randomized trial are lacking.

Methods: Eighty patients who met the NIH criteria were recruited and randomized to receive either LRYGBP (n = 40) or LMGBP (n = 40). The minimum postoperative follow-up was 2 years (mean, 31.3 months). Perioperative data were assessed. Late complication, excess weight loss, BMI, quality of life, and comorbidities were determined. Changes in quality of life were assessed using the Gastro-Intestinal Quality of Life Index (GIQLI).

Results: There was one conversion (2.5%) in the LRYGBP group. Operation time was shorter in LMGBP group (205 versus 148, P < 0.05). There was no mortality in each group. The operative morbidity rate was higher in the LRYGBP group (20% versus 7.5%, P < 0.05). The late complications rate was the same in the 2 groups (7.5%) with no reoperation. The percentage of excess weight loss was 58.7% and 60.0% at 1 and 2 years, respectively, in the LPYGBP group, and 64.9% and 64.4% in the LMGBP group. The residual excess weight <50% at 2 years postoperatively was achieved in 75% of patients in the LRYGBP group and 95% in the LMGBP group (P < 0.05). A significant improvement of obesity-related clinical parameters and complete resolution of metabolic syndrome in both groups were noted. Both gastrointestinal quality of life increased significantly without any significant difference between the groups.

Conclusion: Both LRYGBP and LMGBP are effective for morbid obesity with similar results for resolution of metabolic syndrome and improvement of quality of life. LMGBP is a simpler and safer procedure that has no disadvantage compared with LRYGBP at 2 years of follow-up.

FIGURE 1. View of completed retrocolic, retrogastric laparoscopic Roux-en-Y gastric bypass. The gastric pouch is estimated to be 20 mL in volume. The Roux limb is 100 to 150 cm in length and is retrocolic and retrogastric in position. The mesentery defect is closed with interrupted sutures.

FIGURE 2. View of completed laparoscopic mini-gastric bypass. The narrow gastric tube roughly the diameter of esophagus (approximate 1.5 cm wide) is created parallel to the lesser curvature and up to the angle of His. Intraoperative endoscopy is used as a stent during the division of the stomach and assists in the anastomosis. The antecolic gastroenterostomy is created at the small bowel 200 cm distal to the Trietz ligament.

FIGURE 3. Upper gastrointestinal study immediately after LRYGBP (A) and 2 years later (B). A mark adaptation of R-Y limb was observed that resulted in inadequate weight loss in this patient.